Visceral adipose tissue and incident cardiovascular disease among individuals without diabetes: an analysis of 15 prospective cohorts from 7 countries in Latin America
Abstract
Background: Visceral adipose tissue (VAT) may causally contribute to cardiovascular disease (CVD); however, evidence in Latin America is limited. Here, we evaluated the association between estimated VAT (eVAT) and incident CVD among individuals without diabetes and estimated its population-attributable fraction (PAF) using data from the Cohorts Consortium of Latin America and the Caribbean (CC-LAC). Methods: We pooled data from 15 prospective cohorts across 7 countries (n = 23,097; 62% women [n = 14,383], median age 51 years). Baseline eVAT (in grams [g]) was estimated using the Metabolic Score for Visceral Fat (METS-VF) index, incorporating age, sex, an insulin resistance index, and waist-to-height ratio. The primary outcome was incident CVD events, including fatal and non-fatal outcomes. Cause-specific Cox proportional hazards models estimated adjusted hazard ratios (aHR). PAF estimates used scenario-based eVAT quartile reductions. Findings: Over a median follow-up of 4 years (113,622 person-years), 436 participants (1.9%) experienced an incident CVD event (174 fatal; 262 non-fatal). Uniformly age- and sex-standardized incidence rates were 3.8 (95% CI: 3.5-4.2) per 1000 person-years. Each 100 g increase in eVAT was associated with a 4% higher CVD hazard (aHR 1.04, 1.03-1.06). Compared with Q1 (<735 g), those in Q3 (1069-1441 g) and Q4 (≥1441 g) had a higher CVD hazard (Q3 aHR: 1.78 [1.28-2.49]; Q4 aHR: 2.03 [1.48-2.79]; p-for-trend <0.001). Associations were stronger for non-fatal events. In PAF estimates, shifting individuals from Q4 to lower quartiles could prevent 8.8% (2.8%-14.7%) of CVD events over 10 years. Interpretation: Higher eVAT was associated with increased CVD risk in Latin America, supporting the view that modest VAT reductions could decrease regional CVD burden. Funding: CC-LAC was funded by the Wellcome Trust.
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BibTeX
@article{torreschavez2026visceral,
title = {{Visceral adipose tissue and incident cardiovascular disease among individuals without diabetes: an analysis of 15 prospective cohorts from 7 countries in Latin America}},
author = {Mario Cesar Torres-Chavez and Jesus Ernesto Martinez-Luna and Maria Fernanda Suarez-Velazquez and Carlos Alberto Fermin-Martinez and Rodrigo M. Carrillo-Larco and Dalia Stern and Ian R. Hambleton and Paulo Lotufo and Mariachiara Di Cesare and Anselm Hennis and Catterina Ferreccio and Vilma Irazola and Pablo Perel and Edward W. Gregg and J Jaime Miranda and Majid Ezzati and Goodarz Danaei and Omar Yaxmehen Bello-Chavolla and Neftali Eduardo Antonio-Villa and Adolfo Rubinstein and Aaron Salinas-Rodriguez and Adrian Cortes-Valencia and Alexandre C. Pereira and Alvaro C.C. Maciel and Alvaro Ruiz-Morales and Andrea Huidobro and Andrea R.V.R. Horimoto and Antonio Bernabe-Ortiz and Berenice Rivera-Paredez and Betty S. Manrique-Espinoza and Blanca H. Ceballos and Carla D.O. Bernardo and Carlos A. Aguilar-Salinas and Cassiano R. Rech and Cecilia Baccino and Paula Parnizari and Claudia Bambs and Clicerio Gonzalez-Villalpando and David A. Gonzalez-Chica and Donaji Gomez-Velasco and Elard Koch and Eleonora D’orsi and Fernando L. Herkenhoff and Fiorella Tartaglione and Flavio D. Fuchs and Gilbert Brenes-Camacho and Gladys E. Maestre and Gloria Beckles and Gonzalo Grazioli and Horacio A. Carbajal and Jackie A. Cooper and Jesus D. Melgarejo and Joao Luiz Bastos and Jorge Salmeron and Jorge Tartaglione and Jose G. Boggia and Jose G. Mill and Juan E. Blumel and Karen G. Peres and Karen Oppermann},
journal = {The Lancet Regional Health - Americas},
year = {2026},
month = oct,
doi = {10.1016/j.lana.2026.101603},
url = {https://hal.science/hal-05791925v1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Visceral adipose tissue and incident cardiovascular disease among individuals without diabetes: an analysis of 15 prospective cohorts from 7 countries in Latin America
AU - Mario Cesar Torres-Chavez
AU - Jesus Ernesto Martinez-Luna
AU - Maria Fernanda Suarez-Velazquez
AU - Carlos Alberto Fermin-Martinez
AU - Rodrigo M. Carrillo-Larco
AU - Dalia Stern
AU - Ian R. Hambleton
AU - Paulo Lotufo
AU - Mariachiara Di Cesare
AU - Anselm Hennis
AU - Catterina Ferreccio
AU - Vilma Irazola
AU - Pablo Perel
AU - Edward W. Gregg
AU - J Jaime Miranda
AU - Majid Ezzati
AU - Goodarz Danaei
AU - Omar Yaxmehen Bello-Chavolla
AU - Neftali Eduardo Antonio-Villa
AU - Adolfo Rubinstein
AU - Aaron Salinas-Rodriguez
AU - Adrian Cortes-Valencia
AU - Alexandre C. Pereira
AU - Alvaro C.C. Maciel
AU - Alvaro Ruiz-Morales
AU - Andrea Huidobro
AU - Andrea R.V.R. Horimoto
AU - Antonio Bernabe-Ortiz
AU - Berenice Rivera-Paredez
AU - Betty S. Manrique-Espinoza
AU - Blanca H. Ceballos
AU - Carla D.O. Bernardo
AU - Carlos A. Aguilar-Salinas
AU - Cassiano R. Rech
AU - Cecilia Baccino
AU - Paula Parnizari
AU - Claudia Bambs
AU - Clicerio Gonzalez-Villalpando
AU - David A. Gonzalez-Chica
AU - Donaji Gomez-Velasco
AU - Elard Koch
AU - Eleonora D’orsi
AU - Fernando L. Herkenhoff
AU - Fiorella Tartaglione
AU - Flavio D. Fuchs
AU - Gilbert Brenes-Camacho
AU - Gladys E. Maestre
AU - Gloria Beckles
AU - Gonzalo Grazioli
AU - Horacio A. Carbajal
AU - Jackie A. Cooper
AU - Jesus D. Melgarejo
AU - Joao Luiz Bastos
AU - Jorge Salmeron
AU - Jorge Tartaglione
AU - Jose G. Boggia
AU - Jose G. Mill
AU - Juan E. Blumel
AU - Karen G. Peres
AU - Karen Oppermann
PY - 2026
DA - 2026/10/11
JO - The Lancet Regional Health - Americas
DO - 10.1016/j.lana.2026.101603
UR - https://hal.science/hal-05791925v1
AB - Background: Visceral adipose tissue (VAT) may causally contribute to cardiovascular disease (CVD); however, evidence in Latin America is limited. Here, we evaluated the association between estimated VAT (eVAT) and incident CVD among individuals without diabetes and estimated its population-attributable fraction (PAF) using data from the Cohorts Consortium of Latin America and the Caribbean (CC-LAC). Methods: We pooled data from 15 prospective cohorts across 7 countries (n = 23,097; 62% women [n = 14,383], median age 51 years). Baseline eVAT (in grams [g]) was estimated using the Metabolic Score for Visceral Fat (METS-VF) index, incorporating age, sex, an insulin resistance index, and waist-to-height ratio. The primary outcome was incident CVD events, including fatal and non-fatal outcomes. Cause-specific Cox proportional hazards models estimated adjusted hazard ratios (aHR). PAF estimates used scenario-based eVAT quartile reductions. Findings: Over a median follow-up of 4 years (113,622 person-years), 436 participants (1.9%) experienced an incident CVD event (174 fatal; 262 non-fatal). Uniformly age- and sex-standardized incidence rates were 3.8 (95% CI: 3.5-4.2) per 1000 person-years. Each 100 g increase in eVAT was associated with a 4% higher CVD hazard (aHR 1.04, 1.03-1.06). Compared with Q1 (<735 g), those in Q3 (1069-1441 g) and Q4 (≥1441 g) had a higher CVD hazard (Q3 aHR: 1.78 [1.28-2.49]; Q4 aHR: 2.03 [1.48-2.79]; p-for-trend <0.001). Associations were stronger for non-fatal events. In PAF estimates, shifting individuals from Q4 to lower quartiles could prevent 8.8% (2.8%-14.7%) of CVD events over 10 years. Interpretation: Higher eVAT was associated with increased CVD risk in Latin America, supporting the view that modest VAT reductions could decrease regional CVD burden. Funding: CC-LAC was funded by the Wellcome Trust.
SN - 2667-193X
ER -